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RN CCM, experience with Case Management and Utilization Review

Location:
Cincinnati, OH
Posted:
October 02, 2023

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Resume:

Tracey N. Thomas

**** ******** *****

Cincinnati, Ohio 45247

513-***-****

Professional Goal

To apply my current skills and knowledge in a diverse practice setting that enables

continuous education and advancement in the nursing profession.

Academic Preparation

Bachelors of Science in Nursing. Awarded by University of Cincinnati (1992)

Experience

*30 years as a Registered Nurse

* 25 years of Case Management experience

*7 years of Supervisory and/or Team Lead experience

*5 year Management Role

Full Time Positions Held

TriHealth Rehabilitation Hospital

Prospective Payment System Mgr April 2016-present

Interim Chief Nursing Officer September 2018-May 2019

Responsibilities include:

Work in collaboration with the PPS Coordinator, treating team and physician to gather data required for creation of the In-patient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) in E-rehab Data, review and confirm Quality Indicator data, retrieve diagnostic codes (ICD 10) from the physician documentation in the medical record, codes the medical record in accordance with coding convention, finalizes the IRF-PAI for all patients in E-Rehab Data, locks and transmits the IRF-PAI for Medicare patients in accordance with the federal final rule, and creates an abstract of the diagnostic codes in the HMS (billing) system.

Mercy Health

Positions Held

Manager, Care Model Education May 2015-March 2016

& Training

Responsibilities include:

*Developed training materials, identify training opportunities, conduct onboarding, develop mentoring program, program assessment and evaluation.

*Provided support for developing Market implementation plans for care transitions programs, ambulatory care coordination programs, wellness and preventative health programs or other care management programs and services maintained by the PHSO through mentoring and educating Ambulatory Care Coordination teams across all Mercy Markets.

RN Care Coordinator October 2014-August 2015

Responsibilities include:

*Provide transition calls and community resource assistance to patients as needed following hospitalizations and ER visits.

*Provide Care Coordination to patients with chronic diseases by promoting, supporting and motivating patients to manage their disease, reduce risk factors, improve compliance with evidence-based-medicine, assist with resources as needed and promote healthy lifestyle changes.

*Provide patient and family education as needed.

*Coordinate services across the continuum including inpatient hospitalizations, skilled nursing facilities, home health, Primary Care Settings and specialist services.

*Assist patients with obtaining community based assistance.

*Assist patients with prescription drug assistance based on financial barriers.

Mercy Health Connect-Pilot Program April 2013-December 2014

Team Lead

Responsibilities include:

*Lead day to day team operations of Mercy Health Connect Pilot Program.

*Assisted in the development of the program from the initial start of the program

*Completed Medigold Quality Improvement Program for qualified patients.

*Collaborated with Inpatient UR staff, Primary Care Physician in multiple Mercy Physician Practices and Care Coordination Team for Mercy Health.

*Provided transition calls and community resource assistance to patients as needed.

Mercy Health/HealthSpan

Population Health RN January 2011-January 2014

Team Lead **Team Lead Role began May 2011

Responsibilities include:

*Lead day to day team operations of Population Health Team, problem solves, promoted

project completion, and participates in staff development.

*Provided leadership and mentoring in the development of professional staff.

*Provided Disease Management and Personal Health Management Services by promoting, supporting and motivating members to manage their chronic disease, reduce risk factors, improve compliance with evidence-based-medicine and live a healthy lifestyle.

*Utilized positive psychology to assist members in goal and activity setting, progress tracking and goal realization through E-Coach, telephonically, or face-to-face.

*Utilized consistent and evidence based tools to provide member education and support lifestyle changes.

*Provided population trends to employer groups and collaborate with employer groups to identify initiatives to promote a healthy population.

Senior RN Case Manager October 2007-January 2011

Responsibilities include:

*Provided utilization review and precertification for medical treatment/equipment as needed

*Provided patient education and resources as needed for patients telephonically

*Utilized consistent and evidence based tools to provide member education and support lifestyle changes.

*Provided population trends to employer groups and collaborate with employer groups to identify initiatives to promote a healthy population.

Drake Center

RN Case Manager November 2002-October 2007

Responsibilities include:

* Conduct concurrent medical record reviews to determine level of care, quality and financial compliance with state and federal agencies.

* Develop collaborative relationships with patients, families and healthcare team members to maximize communication, and education.

* Promote effective utilization of resources to assist in achieving desired clinical outcomes within specified timeframe.

*Actively assist with discharge planning in accordance with established criteria.

Humana/Choice Care

RN Case Manager/Personal July 1998-November 2002

Nurse Coach

Responsibilities include:

*Provide patient education and resources as needed for patients telephonically

*Early identification of chronic/complex, high risk cases to achieve optimum case management outcomes.

*Interpret and apply standard clinical criteria to medical management activities, consulting with Medical Directors.

* Promote effective utilization of resources to assist in achieving desired clinical outcomes within specified timeframe.

Home Health Plus/Heartland Home Health

RN Case Manager April 1997-July 1998

Performace Improvement Supervisor

Responsibilities include:

* Direct care of patients in home settings.

* Supervise direct caregivers

Drake Center

Graduate Nurse/RN July 1992-1994

Responsibilities include:

*Direct care of patients, status post traumatic brain injury, spinal cord injury, cerebral vascular accident, as well as medically compromised patients requiring inpatient rehabilitation.

*Provided patient and family teaching.

RN Shift Supervisor 1994-April 1997

Responsibilities include:

*Direct patient care of neurological and spinal cord injury patients.

*Participated in team conferences and provided emergency care as needed.

*Provided patient and family teaching, and discharge planning.

*Served as charge nurse, assisted Nurse Manager with schedules, staffing, payroll and evaluation of staff.

Part Time Positions Held

Interim Home Health

RN Field Staff/PRN June 2004-2011

Responsibilities include:

* Direct care of patients in home settings.

Home Health Plus/Heartland Home Health

RN Field Staff/PRN July 1998-2001

Responsibilities include:

* Direct care of patients in home settings.

Certifications

Basic Life Support August 2021-August 2023

Certified Case Manager December 2001-Present

Certified Rehabilitation RN December 1996-Present

REFERENCES AVAILABLE UPON REQUEST



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